The International Journal of Romanian Society of Endocrinology / Registered in 1938

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July - September 2018, Volume 14, Issue 3
Case Report

Sima A, Sporea I, Timar R, Vlad M, Braha A, Popescu A, Nistorescu S, Mare R, Sirli R, Albai A, Albai O, Diaconu L, Sorescu T, Popescu S, Sima L

Non-invasive Assessment of Liver Steatosis and Fibrosis Using Transient Elastography and Controlled Attenuation Parameter in type 2 Diabetes Patients

Acta Endo (Buc) 2018, 14 (3): 394-400
doi: 10.4183/aeb.2018.394

Context. Nonalcoholic fatty liver disease is common in type 2 diabetes mellitus patients, being difficult to diagnose. Objective. To find a correlation between elastographic parameters and lab results, for facilitating the diagnosis of nonalcoholic fatty liver disease. Design. This is a cross sectional study, conducted at the Departments of Diabetes, Nutrition and Metabolic Diseases, and Gastroenterology and Hepatology, of the Clinical Emergency Hospital “Pius Brinzeu” Timisoara. Subjects and Methods. We included 190 type 2 diabetes mellitus patients, collected data regarding medical history, clinical and biological features and applied the Alcohol Use Disorders Identification Test. We excluded patients with other causes of liver disease. Liver steatosis and fibrosis were evaluated through transient elastography, yielding two parameters: liver stiffness as an indicator of liver fibrosis stage, expressed in kPa, and liver steatosis stage, assessed by controlled attenuation parameter, expressed in dB/m. Data were analyzed using SPSS 15. Results. The analyzed group comprised 113 patients. Elastographic measurements showed that 93.8% of the patients had steatosis (controlled attenuation parameter ≥232.5 dB/m) and 70.8% severe steatosis (controlled attenuation parameter ≥290 dB/m). Severe steatosis was more common in women (75.7%) than in men (68.1%) (p<0.0001). From the patients with steatosis, 47.2% had liver stiffness values suggestive for fibrosis and 19.8% for cirrhosis. Most patients with steatosis and severe fibrosis were obese (66.7%). Triglycerides/HDLc ratio >4 correlated with hepatic steatosis (p=0.04), being more common in patients with severe fibrosis/cirrhosis (58.3%) than in those with absent or mild fibrosis (36.2%). Conclusions. Our study found a clear correlation between type 2 diabetes mellitus and the presence of liver steatosis. It correlates with body mass index, waist circumference (in men) and triglycerides/HDLc ratio. Controlled attenuation parameter is a useful noninvasive method for detection and quantification of liver steatosis.

Keywords: type 2 diabetes mellitus, nonalcoholic fatty liver disease, Transient Elastography, Controlled Attenuation Parameter, triglycerides/HDLc ratio

Correspondence: Mihaela Vlad MD, “Victor Babes” University of Medicine and Pharmacy, Dept. of Endocrinology, 1st Eftimie Murgu Square, Timisoara, Timis, 300239, Romania, E-mail: